PATENT APPLICATION FEE DETERMINATION RECORD
Effective January 1 , 2003
Application or Docket Number
CLAIMS AS FILED - PART I
TOTAL CLAIMS
FOR
NUMBER FltEO
NUMBER EXTRA'
TOTAL CHARGEABLE CLAIMS
• <»-
INDEPENDENT CLAIMS
.1/ minus 3 =
MULTIPLE DEPENDENT CLAIM PRESENT
p
• ft the difference in column 1 is (ess than zero, enter "O* in column 2
CLAIMS AS AMENDED - PART II
Total
\ttdepetuMt
(Column 1)
CLAIMS
REMAINING
AFTEfl
AMENDMENT
■2D
•-£L
Minus
Minus
(Column g) (Column 3)
HIGHEST
NUMBER .
PREVIOUSLY
PAID FOR
sg2
I FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
lDtNT<
PRESENT
EXTRA
4.
ED
//>), l.«J ,Vh
(Column il . (Column 2i • (Column $)
tlnh
CLAIMS
REMAINING
AFTER
AMENDMENT
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
Total
Minus
Independent
■4
Minus
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM □
(Column 1
o
ttl
1 CUIUS 1
REMAINING
AFTER
AMENDMENT
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
s
a
z
Total
Minus
ut
s
Independent
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
SMALL ENTITY
TYPE
OTHER THAN
OR SMALL ENTITY
* Utheernryiartumnlblassihantheem^
m It Ihe tithe* Number Prevtousty Paw For* IN THIS SPACE bless than 20. enters*
-*n the "Highest Number Previously Patt For* IN THIS SPACE b less than 3. enter V
The "Hrflhest Number Previously Paid For* (Total or Independent b die highest nun^
RATE
FEE
RATE
FEE l
BASIC FEE
375.00
OR
BASIC FEE
750.00
X$9=
OR
X$18=
fiL.
X42=
OR
X84=
♦140=
OR
♦280=
TOTAL
*
OR
TOTAL
SMALL ENTITY
OR
OTHER THAN s
SMALL ENTITY
RATE
ADDI-
TIONAL
FEE
RATE
AC
TIO
F
K5I-
NAL
EE.
X$9=
vn
X$18=
X42=
OR
X84=
♦140=
Oft
♦280=
A
ADO IT. FEE
OR
TOTAL
AODITFEE
RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
FEE
X$9«
OR
X$18=
X42=
OR
X84=
♦140=
1 TOtAL
OR
♦280=
AODItFEE
OR
TOTAL
. RATE
ADDI-
TIONAL
FEE
RATE
ADDI-
TIONAL
pep.
X$9=
OR
X$18=
X42«
OR
X84=
♦140=
OR
♦280=
TOTAL
no TOTAL
W " ADOIT FEE
P0RUPTOS75 <R*Lf2fl3 VAC*wi«Pib^O«cfc200C^«S^sinwi^^™ Paitra end Trademark OfBos, VS. DEPARTMENT OF COMMERCE